1. The variable use of heparin through intravenous bolus and flush fluid systems during endovascular stroke treatment, a world-wide survey : insights from instrumental, neuro-psychological and study-related profilesSenta Frol, Faysal Benali, Aymeric Rouchaud, Robrecht R.M.M. . Knapen, Wim H. van Zwam, 2025, izvirni znanstveni članek Povzetek: Background The total amount of heparin administered through flush fluids in stroke patients is not considered in recent trials, possibly influencing main results. We investigated the use of heparin among treating physicians worldwide. Methods We conducted a survey from November 2022 to January 2023 to identify the variability of heparin administration during stroke endovascular treatment (EVT). We calculated the total heparin dose per hour (IU/h) by adding the intravenous (IV)-bolus dose to the amount administered through flush fluids, calculated by a multiplication of the number of infusion bags, drip rate[mL/h] and heparin concentration[IU/L]. Results A total of 315 participants from different countries worldwide completed the survey and 231/315(73%) respondents administer heparin during EVT. The majority administered heparin only through flush fluids (168/231; 72.7%), followed by both IV-bolus and flush fluids (36/231; 16%), and those who used only an IV-bolus (27/231; 11.7%). From the participants that administer heparin through flush fluids, the median heparin concentration was 2000 IU/L (range:100 IU/L-10000 IU/L). The total heparin dose (administered through flush fluids and IV-bolus) among 23 respondents showed a median of 4650 IU/h (IQR:3432–5900). Among the respondents who administer heparin through IV-bolus only, the median was 5250 IU (IQR:3750–7500). Conclusion This survey revealed variable heparin doses administered by physicians worldwide during EVT and reflects the lack of international guidelines. Caution is warranted, specifically during complex/long EVT procedures. Furthermore, heparin flush doses should be considered in future trials regarding periprocedural anticoagulants, since imbalances could potentially confound results.
Ključne besede: heparin, endovascular treatment, stroke
Objavljeno v DiRROS: 26.02.2026; Ogledov: 100; Prenosov: 57
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2. Stroke frequency, associated factors, and clinical features in primary systemic vasculitis : a multicentric observational studyRuth Geraldes, Mónica S. F. Santos, Cristina Ponte, Anthea Craven, Lillian Barra, Joanna C. Robson, Nevin Hammam, Jason Springer, Jöerg Henes, Alojzija Hočevar, 2024, izvirni znanstveni članek Povzetek: Objectives: The cerebral vessels may be affected in primary systemic vasculitis (PSV), but little is known about cerebrovascular events (CVEs) in this population. This study aimed to determine the frequency of CVEs at the time of diagnosis of PSV, to identify factors associated with CVEs in PSV, and to explore features and outcomes of stroke in patients with PSV. Methods: Data from adults newly diagnosed with PSV within the Diagnostic and Classification Criteria in VASculitis (DCVAS) study were analysed. Demographics, risk factors for vascular disease, and clinical features were compared between patients with PSV with and without CVE. Stroke subtypes and cumulative incidence of recurrent CVE during a prospective 6-month follow-up were also assessed. Results: The analysis included 4828 PSV patients, and a CVE was reported in 169 (3.50%, 95% CI 3.00-4.06): 102 (2.13% 95% CI 1.73-2.56) with stroke and 81 (1.68% 95% CI 1.33-2.08) with transient ischemic attack (TIA). The frequency of CVE was highest in Behçet's disease (9.5%, 95% CI 5.79-14.37), polyarteritis nodosa (6.2%, 95% CI 3.25-10.61), and Takayasu's arteritis (6.0%, 95% CI 4.30-8.19), and lowest in microscopic polyangiitis (2.2%, 95% CI 1.09-3.86), granulomatosis with polyangiitis (2.0%, 95% CI 1.20-3.01), cryoglobulinaemic vasculitis (1.9%, 95% CI 0.05-9.89), and IgA-vasculitis (Henoch-Schönlein) (0.4%, 95% CI 0.01-2.05). PSV patients had a 11.9% cumulative incidence of recurrent CVE during a 6-month follow-up period. Conclusion: CVEs affect a significant proportion of patients at time of PSV diagnosis, and the frequency varies widely among different vasculitis, being higher in Behçet's. Overall, CVE in PSV is not explained by traditional vascular risk factors and has a high risk of CVE recurrence.
Ključne besede: cerebrovascular event, primary systemic vasculitis, stroke, transient ischaemic attack
Objavljeno v DiRROS: 26.02.2026; Ogledov: 124; Prenosov: 69
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3. Tenecteplase - what have we learned till now? : a narrative reviewMatija Zupan, Lara Straus, Pawel Kermer, Senta Frol, 2025, izvirni znanstveni članek Povzetek: Tenecteplase (TNK), a genetically modified tissue plasminogen activator, has emerged as a promising alternative to alteplase (ALT) for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Our aim was to synthesize the current clinical evidence on TNK use in AIS patients, comparing efficacy, safety, and workflow benefits to ALT. A narrative review was conducted by searching PubMed and Scopus (January 2024–March 2025) for studies comparing TNK and ALT in AIS. A total of 35 eligible papers were included. Data were grouped by treatment scenario: IVT-only, bridging before endovascular therapy (EVT), and intra-arterial thrombolysis (IAT). The results showed that TNK is non-inferior— and in some analyses, superior—to ALT regarding functional outcomes, especially in large vessel occlusion. TNK facilitates shorter treatment delays due to its single-bolus administration. While some trials report higher rates of intracranial hemorrhage, overall safety and mortality are comparable. In conclusion, TNK appears to exert equivalent or superior efficacy and safety compared to ALT in multiple AIS scenarios. Its pharmacological and logistical advantages support its broader clinical adoption. Further trials are needed, especially for IAT, central retinal artery occlusion, and patients on dabigatran
Ključne besede: tenecteplase, acute ischemic stroke, treatment, narrative review, alteplase
Objavljeno v DiRROS: 23.02.2026; Ogledov: 181; Prenosov: 86
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4. Thrombus composition and the evolving role of tenecteplase in acute ischemic strokeSenta Frol, Matija Zupan, 2025, pregledni znanstveni članek Povzetek: Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide, requiring rapid reperfusion to minimize damage. Current treatments, including intravenous thrombolysis (IVT) with alteplase (rt-PA) and mechanical thrombectomy (MT), face limitations such as thrombolysis resistance, dosing complexity, and reduced efficacy in large vessel occlusions (LVOs) or fibrin-rich clots. Tenecteplase (TNK), a bioengineered thrombolytic agent with superior pharmacokinetics, simplified administration, and higher fibrin specificity, offers promising advantages over rt-PA, including potential synergy with MT and efficacy against resistant thrombi. Direct oral anticoagulants (DOACs) further complicate AIS management, but evidence suggests that DOAC-treated patients may experience better thrombolysis outcomes due to distinct thrombus characteristics. Advances in imaging now enable precise visualization of vessel occlusion and treatment effects, opening opportunities to refine therapies. Combination approaches targeting fibrin thrombus components may enhance thrombolysis and improve outcomes in resistant cases. Future research should explore TNK’s role in intra-arterial (IA) applications, combination therapies, and its interaction with MT to optimize reperfusion strategies. TNK’s simplified use and promising efficacy position it as a potential breakthrough in AIS management, with the potential to improve functional recovery and reduce treatment complexity.
Ključne besede: thrombus, thrombolysis, tenecteplase, acute ischemic stroke, combination therapies
Objavljeno v DiRROS: 08.01.2026; Ogledov: 444; Prenosov: 117
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7. Mechanical recanalization for acute bilateral cerebral artery occlusion - literature overview with a caseMiran Jeromel, Zoran Miloševič, Janja Pretnar-Oblak, 2020, pregledni znanstveni članek Povzetek: Background. Acute bilateral internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusion is extremely rare and associated with poor clinical outcomes. There are only a few reports in the literature about mechanical thrombectomy being performed for acute bilateral occlusions. The treatment strategies and prognoses (clinical outcomes) are therefore unclear. Methods. A systematic review of the literature was performed through several electronic databases with the following search terms: acute bilateral stroke, mechanical recanalization and thrombectomy. Results. In the literature, we identified five reports of six patients with bilateral ICA and/or MCA occlusion treated with mechanical recanalization. Additionally, we report our experience with a subsequent contralateral large brain artery occlusion during intravenous thrombolytic therapy, where the outcome after mechanical thrombectomy was not dependent on the time from stroke onset but rather on the capacity of collateral circulation exclusively. Conclusions. Acute bilateral cerebral (ICA and/or MCA) occlusion leads to sudden severe neurological deficits (comas) with unpredicted prognoses, even when mechanical recanalization is available. As the collateral capacity seems to be more important than the absolute time to flow restoration in determining the outcomes, simultaneous thrombectomy by itself probably does not lead to improved functional outcomes.
Ključne besede: acute bilateral stroke, mechanical recanalization, thrombectomy
Objavljeno v DiRROS: 12.07.2024; Ogledov: 1159; Prenosov: 607
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8. Non-contrast computed tomography in the diagnosis of cerebral venous sinus thrombosisJernej Avsenik, Janja Pretnar-Oblak, Katarina Šurlan Popović, 2016, izvirni znanstveni članek Povzetek: Due to the diversity of underlying factors and the absence of a uniform treatment approach, diagnosis and management of patients with cerebral venous sinus thrombosis (CVST) remain a challenging task.1 CVST represents 0.5% to 1% of all strokes and affects approximately 5 patients per million every year, but has a higher frequency among younger patients. Typical acquired risk factors include recent surgery, trauma, pregnancy, postpartum state, antiphospholipid syndrome, cancer and use of oral contraceptives. Cases of inherited thrombophilia include Antithrombin III, Protein C and Protein S deficiency, factor V Leiden positivity, prothrombin gene mutation and hyperhomocisteinemia. Infection of parameningeal spaces (ears, paranasal sinuses, oral cavity, face and neck) is common cause of CVST in pediatric population but rare in adults. The symptoms of CVST are not specific. The most common complaint is headache which occurs in up to 90% of patients. Additionally, abnormal vision, any of the symptoms of stroke and seizures have been described. In the past D-dimer levels appeared to be of value as an initial screening test. A study in 2004 evaluated the sensitivity of D-dimer to be 97.1% and specificity 99.1%.8 However, later studies showed that up to 10% of patients with CVST have a normal D-dimer. As it is fast, affordable and widely available, non-contrast computed tomography (NCCT) is the most frequently performed imaging study for evaluation of patients with new headache, focal neurological abnormalities, seizure, or change in mental status. A typical imaging finding in patients with CVST is direct visualization of a hyperattenuating thrombus in the occluded sinus (dense sinus sign). Occasionally, NCCT may only show indirect signs of thrombosis, including diffuse brain edema and parenchymal hemorrhage. Sensitivity of NCCT in the diagnosis of CVST was previously considered rather poor. However, using modern multidetector row CT scanners, recent studies report higher sensitivity and specificity values. In addition, Buyck et al. suggest measurement of the venous sinus attenuation to increase the diagnostic yield of the examination. Therefore, the goal of the present study was to evaluate the diagnostic accuracy of NCCT in the diagnosis of CVST in the emergency setting
Ključne besede: cerebral venous sinus thrombosis, computed tomography, stroke, radiologija, računalniška tomografija, diagnostika, možganski venski sinusi
Objavljeno v DiRROS: 09.05.2024; Ogledov: 1215; Prenosov: 733
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